The SAH's Spasm!

Topic: Adult

A 43-year-old man is referred from another hospital to you for further management of cerebral vasospasm. He developed acute subarachnoid hemorrhage. All of the following statements regarding arterial vasospasm following subarachnoid hemorrhage (SAH) are correct, except:

This question was created on May 29, 2009 by rednucleus.This question was last modified on June 06, 2009.

ANSWERS AND EXPLANATIONS

A) Clinical ischemia is not typically seen before day 4 post-ictus

This answer is incorrect.

Cerebral vasospasm is mainly seen in the arteries surrounded by the subarachnoid blood; remote arteries may be affected but this is uncommon and usually not that significant. Clinical ischemia is not typically seen before day 4 post-ictus; peaks at day 10-14 post ictus. The only ways to diagnose it is by doing trans-cranial Doppler study or cerebral angiography. The severity of the arterial spasm is closely related to the amount of the surrounding subarachnoid blood and thus is less common where less blood is seen, e.g. traumatic SAH or SAH following AVM rupture. Cerebral vasospasm develops in 30% of patients; much more common than re-bleeding!
(See References)

B) Is mainly seen in the arteries surrounded by the subarachnoid blood

This answer is incorrect.

Cerebral vasospasm is mainly seen in the arteries surrounded by the subarachnoid blood; remote arteries may be affected but this is uncommon and usually not that significant. Clinical ischemia is not typically seen before day 4 post-ictus; peaks at day 10-14 post ictus. The only ways to diagnose it is by doing trans-cranial Doppler study or cerebral angiography. The severity of the arterial spasm is closely related to the amount of the surrounding subarachnoid blood and thus is less common where less blood is seen, e.g. traumatic SAH or SAH following AVM rupture. Cerebral vasospasm develops in 30% of patients; much more common than re-bleeding!
(See References)

C) Can be confirmed by trans-cranial Doppler study or cerebral angiography

This answer is incorrect.

Cerebral vasospasm is mainly seen in the arteries surrounded by the subarachnoid blood; remote arteries may be affected but this is uncommon and usually not that significant. Clinical ischemia is not typically seen before day 4 post-ictus; peaks at day 10-14 post ictus. The only ways to diagnose it is by doing trans-cranial Doppler study or cerebral angiography. The severity of the arterial spasm is closely related to the amount of the surrounding subarachnoid blood and thus is less common where less blood is seen, e.g. traumatic SAH or SAH following AVM rupture. Cerebral vasospasm develops in 30% of patients; much more common than re-bleeding!
(See References)

D) Develops in 30% of patients

This answer is incorrect.

Cerebral vasospasm is mainly seen in the arteries surrounded by the subarachnoid blood; remote arteries may be affected but this is uncommon and usually not that significant. Clinical ischemia is not typically seen before day 4 post-ictus; peaks at day 10-14 post ictus. The only ways to diagnose it is by doing trans-cranial Doppler study or cerebral angiography. The severity of the arterial spasm is closely related to the amount of the surrounding subarachnoid blood and thus is less common where less blood is seen, e.g. traumatic SAH or SAH following AVM rupture. Cerebral vasospasm develops in 30% of patients; much more common than re-bleeding!
(See References)

E) The severity of the vasospasm is not related to the amount of the surrounding subarachnoid blood

This answer is correct.

Cerebral vasospasm is mainly seen in the arteries surrounded by the subarachnoid blood; remote arteries may be affected but this is uncommon and usually not that significant. Clinical ischemia is not typically seen before day 4 post-ictus; peaks at day 10-14 post ictus. The only ways to diagnose it is by doing trans-cranial Doppler study or cerebral angiography. The severity of the arterial spasm is closely related to the amount of the surrounding subarachnoid blood and thus is less common where less blood is seen, e.g. traumatic SAH or SAH following AVM rupture. Cerebral vasospasm develops in 30% of patients; much more common than re-bleeding!
(See References)